“I cannot do the push-ups for you,” consultant cardiologist and lifestyle medicine practitioner Prof Robert Kelly tells patients. But he can help them develop healthy habits for self-care.
Habits that stick. Unlike the estimated 80 per cent of new year resolutions that are broken within less than three weeks.
Heart disease is the number one killer in Ireland. It can hit at any age, points out Prof Kelly, author of the newly published The Heart Book – Making Positive Changes for a Healthy and Happier Life (Orpen Press). The fragility of life was driven home to him during his last year in medical school, when he lost his 21-year-old brother to sudden cardiac arrhythmic death.
Most people are aware of lifestyle improvements they could make to protect their beating hearts. But these changes are often low on the list of priorities in the busyness of life until, perhaps, a big health scare. Or the sudden death of a family member or friend.
Yet, as Prof Kelly progressed through his medical career performing the potentially life-saving interventions of surgery, stents and prescribing medication, he could see this was often not the answer. Patients were coming back, either needing the procedure repeated or another problem had developed.
“The reason the patients come back sick after the stents or the surgery is that the tablets aren’t antidotes for bad diets.” But medical training had not taught him anything about how to help patients change their behaviour.
“If you direct people and tell them what to do, that doesn’t work. You have to learn how to coach patients. You have to be able to listen to patients.” A typical consultant’s workload does not allow for that. “While we have great nutritionists, great gyms and great people out there who help you do everything, the vast majority of people don’t hang around for those things. They don’t do them or they see them as a cost. Or they judge themselves and say it did not work before, it is not going to work now.”
They still look to doctors to solve their health problems.
In trying to devise a better approach for patients, Prof Kelly heard about a new speciality – lifestyle medicine – which he embraced through training in the US in 2014. Six pillars of lifestyle medicine, which can prevent, treat and reverse chronic diseases that cause heart disease, are:
- Physical activity
- Healthy eating
- Stress management
- Sleep management
- Social connection
- Addictions (smoking, alcohol, drugs)
“In cardiology, it’s very valuable because there’s overwhelming evidence that you can treat heart disease, and in some cases you can reverse heart disease, as a consequence of following the principles with lifestyle medicine.”
In fine-tuning his “whole heart health” approach, he also became a certified coach in Tiny Habits, devised by social scientist BJ Fogg of Stanford University. “The big shift in trying to change behaviour is you have to take responsibility yourself,” says Prof Kelly, who is medical director for lifestyle health and wellbeing at the Beacon Hospital in Dublin. “Unless you do that, no matter what you try to do, it won’t happen.”
People also have to understand that altering habits is not an instant intervention, which is how they might view a stent or surgery. “You have to put in the miles or the effort for the change to happen, and that’s just the way it is. It comes down to what you value in life. And the challenge with that is a lot of people do not consider health important enough.”
Why?
“We don’t think,” replies Prof Kelly succinctly. “We all go to meetings after meetings, most of which achieve nothing. You come home and you sit in front of the TV and you binge-watch Netflix, because you’re so exhausted at the end of the day, it’s instinctive. Or you eat late at night knowing that you didn’t sleep so well the previous night for exactly the same reason, but you still do it.”
However, with a fresh mindset, you can live your life completely differently, he asserts. January 1st “is a really nice time to reset because everybody does that”. He is not talking about an instant overhaul, but a change of attitude that will make a gradual but permanent difference. Prioritising personal health does not have to be about denial; a resolution might be to spend more time with the children; to ring-fence time each day for yourself; to take more holidays or recalibrate your approach to work.
“It’s just a great opportunity to make purposeful changes in your life and see them through.” Here is some of Prof Kelly’s advice to do that:
Pick one goal for your health
It needs to be realistic for you. To change your behaviour to achieve that aim, “you have to want to do it to 100 per cent, not 50 per cent”. Most of the people he coaches are aiming to lose weight for the sake of their cardiovascular health. But it is important the goal is measurable rather than just aspirational, eg losing 6kg by St Patrick’s Day. Or running 5k or 10k perhaps; or completing X lengths of your local swimming pool without stopping.
Consider hydration
Drinking enough water each day is one of the simplest ways to support your heart health. This will also help to control your appetite by partially filling your stomach. Aim to reach at least eight glasses a day.
Devise a plan
You cannot just start randomly and think it will work, he says. Consider what behaviours you are going to have to change to reach your goal. For most people, weight reduction will be about switching to healthier food. Increasing physical fitness will require an incremental training schedule.
Begin slowly
Whatever aspect of your health you choose to address, start with small steps. Pick the easiest thing first, otherwise you won’t do it. However, it must be something that will have an impact on reaching your goal. For those aiming for a healthier diet, think of it as “transitioning”, rather than saying “I can’t eat this” and “I can’t eat that”. Focus, he suggests, on trying to eat five portions of vegetables and two pieces of fruit daily.
If it’s push-ups you want to crack, perhaps do just one when you get up out of bed on January 1st and increase it to two the next day. Meanwhile, some smokers may find having one fewer cigarette a day, rather than going cold turkey, is what works for them with that particular habit.
Build on success
If you are, say, consistently eating more vegetables and fruit, add in greater adherence to the Mediterranean diet or a whole-food, plant-based diet because these are well studied and associated with less heart disease, fewer strokes, less cancer, less Alzheimer’s. Runners, swimmers and walkers can increase their distances and/or speed as they feel able; likewise those on the push-ups and other forms of resistance training.
Trigger your behaviour
Placing prompts for better habits will make them easier to do. This might be putting the water glass on the breakfast table; the fruit bowl in the middle of the kitchen counter; sports clothes by your bed all ready for the morning run or gym workout.
Harness social connection
It is one of the lifestyle medicine pillars and can keep you on track with new behaviours. Maybe it is doing them with others; or asking someone to check in with you regularly on your progress. Prof Kelly has been coaching groups for the past three years and finds that encouraging participants to help each other leads to greater success.
Enjoy the process
You cannot form a new habit if you don’t enjoy doing the behaviour. Fogg recommends that every time you do it, give yourself a pat on the back or a high five celebration, or simply smile to yourself.
“The reason you do that is because you get a certain feeling of how great you are because you did the behaviour,” says Prof Kelly. Yes it might feel difficult or contrived initially. “But if you do that all the time you will find that you actually enjoy what you are doing.”
Track your behaviours
Keep a record of the new actions you are performing. Prof Kelly likes to get an Excel spreadsheet with the goal written at the top and list below the behaviours he is targeting to get there. Score yourself daily: positively for the behaviours you do and negatively for ones you had intended to avoid. People have more success when they write it all down, he says, rather than looking back and trying to remember what they did or didn’t do when.
Think yourself healthy already
This last tip has been reported as a “game-changer” by many of his patients. Imagining you are already a runner, or a chilled person feeling no stress, or somebody who no longer eats junk food, will help you adopt the lifestyle of that person you are aiming to be.
As athletes of all kinds know, your frame of mind is ultimately what determines your success. Olympic medal winners, for example, will have visualised themselves being on that rostrum long before they get there. “Your resolutions don’t work unless you have the plan, you see yourself as having succeeded and you follow yourself through that way.”
For his own health, Prof Kelly has found working on his mindset to be “absolutely transformative”, while continuing to put in smaller steps around activity and eating.
“But I will say that the greatest insight, because of the mindset for me, is becoming self-aware of the things I do, so I’m able to change them.”
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